Associate Professor Litza Kiropoulos is researching the connections between multiple sclerosis (MS) and mental health, and developing targeted treatments to improve the overall wellbeing of people who live with MS.
Q: What drew you to research the connection between MS and mental health?
A: My interest came from my clinical work as a senior clinical psychologist in hospitals, working with neurological patients, particularly those newly diagnosed with MS. I noticed that many people reported significant changes in mood and anxiety symptoms after their diagnosis, but when I searched for evidence-based psychological interventions specifically for people living with MS, I found virtually nothing. There was even less available then than there is now. I thought that gap needed to be filled – and so here I am.
Q: Are depression and anxiety in MS caused by the disease itself, or are they separate issues?
A: Based on my clinical experience and research, it’s likely a combination of factors. There’s evidence suggesting that depression shares the same underlying inflammatory pathway as MS, so when that inflammatory pathway is activated, mood can also be affected. Some research even suggests that depressive symptoms might be prodromal – meaning they show up before other MS symptoms.
But there’s also the psychological impact to consider. MS often affects people aged between 20 and 40 – which are crucial years for career development and a focus on family. An MS diagnosis can disrupt these major life events, lead to losses, and an impact on a person’s sense of identity – which can have a negative impact on mental health.
Q: Why do people with MS need specialised mental health treatment rather than standard depression therapy?
A: People with MS face a unique constellation of symptoms that seem to interconnect. Depression in MS often occurs alongside changes in mood, anxiety, sleep problems, pain, fatigue, and difficulties with sexual function. These symptoms don’t exist in isolation – they influence each other significantly. What makes this particularly complex is that many MS symptoms overlap with depressive symptoms. For instance, fatigue, sleep disturbances, and eating problems are symptoms of both depression and MS. For psychological treatment to be truly effective for people with MS, you need to address all these interconnected issues simultaneously, not just focus on mood alone.
Q: Can you tell us about your research findings so far?
A: I received a grant from MS Australia in 2016-17 to conduct the ACTION-MS trial. We developed and tested a tailored cognitive behavioural therapy (CBT) intervention specifically for people newly diagnosed with MS who had mild to moderate depression. This eight-week program didn’t just focus on mood, it also incorporated strategies for managing anxiety, pain, fatigue, and sleep issues.
We compared this tailored CBT to a supportive listening intervention and found that our specialised CBT was significantly more effective in reducing depression levels.  What’s particularly exciting is that we also saw improvements in cognition – that is, attention and memory improved along with the mood and anxiety symptoms.
Q: What’s next for this research?
A: We’ve since developed ACTION-MS-online, a self-guided version of this therapy that people can access remotely. This will make the treatment much more accessible, especially for people who can’t easily travel to hospital appointments due to fatigue or other MS symptoms. My ultimate goal is to make this type of mental health support part of routine care for everyone newly diagnosed with MS, and to roll it out through MS Plus Wellbeing Centres across Australia and internationally. I’m also working on developing a structured clinical interview that’s MS-specific, covering all the mental health areas that commonly arise – and how MS interacts with life stages like menopause.
Q: You’re also researching biomarkers of depression in MS. Why is this important?
A: Currently, clinicians rely on questionnaires and clinical interviews to assess depression. These are subjective measures. But biomarkers, which can include specific proteins found in blood and saliva, could provide objective measures to help with diagnosis and track treatment progress. If we can identify patterns of markers of inflammation that correlate with depression in MS, we might be able to say, “when this protein is elevated, there’s a higher likelihood of depression.” This could help with early detection and monitoring treatment effectiveness.
We are currently analysing data collected, which included saliva samples at multiple time points, to see how these biomarkers change in response to psychological treatment.
Q: How significant is the mental health burden in MS compared to other conditions
A: This might surprise people, but individuals with MS have the highest rates of depression and anxiety compared to any other chronic disease population. This isn’t just about the psychological adjustment to diagnosis – there may be neurobiological mechanisms at play as well. Research has shown that depression can actually worsen MS symptoms by increasing inflammation and affecting treatment adherence. It becomes a downward spiral: depression can make MS symptoms worse, which then further impacts mental health, relationships, and quality of life.
Q: Many people say MS can be deeply isolating. What’s your perspective on this?
A: Isolation may stem from the fact that many MS symptoms are invisible. Pain, fatigue, and cognitive difficulties aren’t things that other people can see. I frequently hear from clients that they’ve told their partner or family, “I can’t do what I used to do,” but because their symptoms aren’t visible, others don’t always understand. Fatigue in MS is particularly misunderstood. It’s not just about being tired – it’s an all-encompassing mental and physical fatigue that can be completely debilitating. When people don’t understand this, it can lead to relationship conflicts and make individuals feel like they’re going through this alone. I’ve had clients tell me I’m the first person who truly “gets it.” It’s another reason why I think MS-specific therapies can be more effective than ‘supportive listening’ therapies alone.
Q: What’s your ultimate vision for this work?
A: I want to transform how we approach mental health care in MS. People shouldn’t have to suffer in silence. I can’t tell you how many times I’ve heard clients say, “I didn’t realise this was an issue for others,” or “this has been life-changing because now I can manage my fatigue, maintain relationships, even plan for children.”
My ultimate goal is a day when we have evidence-based psychological care that helps people with MS live whole, fulfilling lives. This isn’t just about quality of life, although of course that’s crucial. It also has broader implications for treatment adherence, healthcare costs, and preventing hospital admissions.
Q: What would you say to someone with MS who’s struggling with their mental health?
A: First, know that what you’re experiencing is common and valid. Mental health challenges are incredibly frequent in MS, and you’re not the only one going through them.
I’d tell them that learning new skills and getting a different perspective on managing your symptoms can be truly life changing. We’re teaching people to do things differently, not necessarily to do less. It’s about pacing, being assertive about your needs, and having people support you in that journey.
I’d say that seeking professional psychological support isn’t a sign of weakness. It’s an appropriate way to be heard and learn skills that can dramatically improve your quality of life. The research shows that when we effectively treat depression and anxiety in MS, it benefits not just mental health but physical symptoms, relationships, work capacity, and overall disease management.
And, I’d like to tell them that MS Plus and researchers like me are working towards a time when it will be easy for you to access specialised, tailored and effective mental health support.
Associate Professor Litza Kiropoulos is based at The University of Melbourne and provides clinical psychology services through the Neuroimmunology Centre at Royal Melbourne Hospital. Her research is supported by MS Australia.
